Date CURRENT Right EyeGRADING Left EyeAND YOUR YOUR NEXT VISIT Date Right Eye Grading My grade? Next Visit Example R4 M0 of R4 M1 Next Visit Left Eye Grading WHAT IS THE SCORE? HELP ME SEE… Name: ........................................................ DI consent IABETIC RETINOPATHY to participate:............................ DR Database No. ...................................... My Example grade? of R 3 R M32M 2 Other Pathology Watch your Blood Pressure! Hypertensive retinopathy is a marker for Cardiovascular risk, stroke death. It is often Watch your Bloodand Pressure found with DR. It makes Maculopathy worse. Hypertensive retinopathy is a may marker for reverse DR Treating the Blood Pressure even cardiovascular Risk, Stroke and Death. It is often found with DR. It makes Maculopathy worse. Treating the Blood Pressure may even reverseStroke, DR. heart disease, YOUR HYPERTENSIVE RETINOPATHY GRADING: death Please Consult Your Doctor control this. Grade Retinaltosigns Grade Mild Normal Mild Moderate Moderate Malignant Malignant Retinal signs ARTERY: None thinning, Stroke, heart Modest disease death Artero-venous Artery: Crossing Change. Modest thinning, Arterio-venous crossing Retinalchange. Haemorrhage, Retinal Strong Strong Haemorrhage, Cotton wool spots, Cotton wool spots, exudate Exudate Disc swelling Disc swelling Strong Strong Proliferative DR Proliferative DR carries a high risk of BEST CORRECTED VISUAL ACUITY blindness. It usely requires intervention with laser and may require injection into the eye and surgery. Vitrectomy may be needed to (R) (L) remove blood and repair detached retina. Laserifcan be applied If Refer visual acuity isduring worse this thanoperation. 6/12. the new blood vessels are not controlled they Proliferative can cause severe GlaucomaDR (another cause of blindnessDR andcarries pain). Proliferative a high risk of blindness. It usually requires intervention with laser and may require an injection into the eye and surgery. A Vitrectomy may be Y needed remove blood and OURtoLOGO repair detached retina. Laser is used to control this condition. If the new blood vessels are not controlled they can cause severe Glaucoma (another cause of blindness and pain). Diabetic DIABETIC Retinopathy RETINOPATHY Diabetic Retinopathy (DR) is Diabetic Retinopathy (DR) is aamajor majorcause cause of blindness worldwide. It is progressive of blindness worldwide. It is a progressive diseaseofofthe theretina retinacaused causedbybysugar sugar disease damage damage to the small blood vessels of the to the small blood vessels of the eye. What eye. What is seen in the eye is present in isother seen organs: in the eye is present other heart, kidneyinetc. Theorgans: retina heart, kidney etc. The retina can be screened can be screened by means of Fundus by means of Fundus Photos. Photos. This affects the Central Vision. It is treated by antibody injections into the eye and may require laser. Help meurgently to keep if myyou sight. Get help are R3/R4 or M1/ M2 or your vision is worse than 6/12 DEVELOPED FOR OSSA BY DR S. COOK, THE EYE Diabetic Maculopathy CENTRE , EAST LONDON No Diabetic Retinopathy: My grade? BDR: RNo O; M O R 0; M 0 Observable Diabetic Observable BDR:Retinopathy: My Referable Diabetic Retinopathy: Referable BDR My 1-2;MM0 R R1-2; 1 R 3-4;RM3-4; 2 M1-M2: R0 1DD Radius Example M0 of RO MO Grade? R1-2 M1 2DD Radius Grade? R 3-4 M2 Example Get help! Example of R1-2 M0 of R3-4 M2 Superior Hemi-retina Superior Hemi-retina Inferior Hemi-retina Inferior Hemi-retina No observableRISK: retinopathy: SYSTEMIC YOUR SCORE • Control Blood sugar: 2.5 random < 8 mmol/l; 3 HBA1C <1.5 6 Blood Pressure M < 140/ 80 preferably • Control R = Retinopathy = Maculopathy with an ACE inhibitor. DD = Disc Diameter 3.5 Maculopathy grading: • Dietary measures 4 1 M0 % • Reduce alcohol intake regular • Moderate, Control your Risk Factorsexercise • Diet • Fenofibrate • Stop Smoking • Reduce Alcohol intake • Control Blood Sugar • Exercise • Blood Pressure 140/80 Random < 8 mmo1/L HbA1c < 7 % (individualised) Calculate your own risk : www.riskafrica.co.za Retinopathy Grading • Control lipids: preferably with Fenofibrate R1 Maculopathy grading REFER for poor vision or M2 Refer for poor vision or any Maculopathy (M1/M2) % 4.5 Reducing0.5risk factors for serious adverse 0 effects: 5 • Stop smoking • Refer: may need laser or other treatment. • Re-screen in 6 months Based on the Scottish Retinopathy Grading sugar as for R0-1 M0 • Control SystemBlood and Recommendations • Re-screen in 1 year. 2 Referable retinopathy: sight threatening Observable retinopathy: Established retinopathy RETINOPATHY GRADING M1 None R3 Exudates/blot HE within Refer 2dd months or refer Ophthal 2DD >1DD fovea Lesions within Blot Haemorrhage > 4 blot haemorrhage in one hemi-retina >4 blot haemorrhage in one hemi-retina R3 Re-screen 1 year 6 Re-screen 1 R2 Rescreen M1 R1 Microaneurysm,Re-screen 1 year Blot Haemorrhage, Microaneurism, year Cotton wool spots R2 None Re-Screen 1 Year Cotton wool spots Rescreen 1 year MO RORetinopathy No Lesions grading >1dd fovea Re-screen 1 year > 4 blot haemorrhage in both hemi-retinas VenousinbeadingRefer >4 blot haemorrhage both hemi-retinas Ophthal. IRMA Refer Ophthal (May need laser) Venous R4 beading New Vessels Refer Ophthal (laser) IRMA M2 M2 ReferRefer Lesions within Exudates/blot HE within fovea 1DD1dd of fovea Ophthal ophthal. P = Photocoaguation Present R6 R4 Re-screen 6 months Inadequate New Vessels Visualisation Refer. Dilate & Rescreen Refer if R3/R4/M1/M2 P = Photocoaguation Present